With increasing rates of overweight and obesity among children and adolescents in the United States, there is an urgent need for effective weight loss treatments for younger patients. Recently, bariatric surgery has been considered as a treatment for seriously overweight adolescents because of the potential for substantial decreases in weight and subsequent improvements in physical health. The broad aim of this Mentored Patient- Oriented Career Development Award (K23) is to examine the interaction of psychological factors and serious overweight to determine if particular patterns of observable psychological symptoms (psychological phenotypes) are helpful in predicting outcomes of bariatric surgery. This project represents a crucial first step in a program of research to understand and address the interaction between mental and physical health among severely obese adolescents seeking bariatric surgery. This K23 application describes a plan of training and research for the candidate to become an independent clinical researcher with expertise in measuring relationships between mental and physical health over time and developing and validating novel treatments for eating and weight disorders in adolescence. The research plan involves: (1) the longitudinal prospective measurement of psychopathology among severely obese adolescents enrolled in a bariatric surgery program, and (2) the development and pilot testing of a treatment intervention delivered via telemedicine. Secondary aims of this application include evaluating the effect of psychiatric symptoms and the treatment intervention on compliance with post-surgery follow-up appointments and weight loss. The proposed research will require the candidate to obtain additional training in the treatment of obese adolescents, the provision of remote treatment (telemedicine), and longitudinal and treatment outcome research. Data from the proposed study will be broadly applicable to the study of interactions between psychological factors and compliance with treatment for youth with chronic health conditions. The results of the proposed K23 award will also be used in the development of a R-level grant application to conduct a larger trial evaluating the efficacy of the telemedicine treatment intervention.